We polled family doctors from across the country, and they laid down the law on eight things they wish we’d do—or stop doing.

According to our panel of general practitioners, Canadians aren’t always doing what they should to make the most of doctor visits—and skipping out on these crucial tactics could lead to a delay in diagnosing serious conditions. Here’s what our experts say you should add to your patient checklist.

1. Stop feeling shy

Many of us hesitate to talk to our physicians about sensitive issues (think substance abuse or sexual health—or even gender identity). But honesty and openness are important, both for fostering a good doctor-patient relationship and for ensuring that you get the best care, says Dr. Laura Pripstein, medical director of the Sherbourne Health Centre in Toronto and a staff physician on the family health team. That’s why it’s OK to try out a doc before committing. Dr. Pripstein recommends booking an initial visit to see if your potential doctor is a good fit. “You want to see if this person seems like someone you can talk to, someone you feel comfortable with,” she says. And if you don’t think your doctor understands or respects your concerns, don’t be afraid to find someone new. “If you feel you can’t ask questions that might be embarrassing, you don’t have the right provider,” says Dr. Pripstein.

2. Don’t come to your appointments unprepared

Get the most out of your time—and your doc’s—by arriving at your appointment with a clear plan for what you want to discuss, says Dr. David Ross, an associate professor of family medicine at the University of Alberta in Edmonton. “It’s good to have patients think about their problems from when the issue began, then look at it chronologically to the present,” says Dr. Ross. Making a prioritized point-form list in advance helps ensure that you don’t forget anything or mix up the order of events, he says. Then, work with your doctor to address the most serious issues first.

3. Choose your family doc over the walk-in clinic whenever you can

Yes, a clinic is convenient, but what we gain in easy access, we lose in familiarity. “I think it’s really valuable if people can connect with a family physician who they’ll be able to see long term, rather than just looking for the quickest way to access care,” says Dr. Maurianne Reade, a physician with the Manitoulin Central Family Health Team in Mindemoya and M’Chigeeng First Nation, Ont. A family doctor will know your medical history and will keep it in mind when suggesting treatment—so, for example, if you’ve recently taken several courses of antibiotics for a UTI, your physician will likely look for a different course of action if you come in with another infection. According to the most recent statistics, about 4.5 million Canadians don’t have a regular family doctor. If that’s you, contact your provincial College of Physicians and Surgeons, or check to see if your region has an online registry (Ontario has Health Care Connect, while Quebec launched a web-based family doctor finder last year). “It’s important to know that we doctors are privileged to share in your stories and to help you through difficult times,” says Dr. Reade.

4. Share what’s happening in your life

There’s a reason your doctor wants to know where you’re working, if you’re dating and how the kids are—and it’s not just because she likes you. (Though she does, we’re sure.) Physicians need a picture of their patients’ lives beyond their specific health symptoms and conditions, especially when they’re first getting to know you, says Dr. Stephen Wetmore, the family medicine chair at the Schulich School of Medicine & Dentistry at Western University in London, Ont. “Doctors need to know these things to understand how your lifestyle and habits may be influencing your health,” he says. So when you’re talking about your exercise habits, your health history and whether you smoke, drink or use drugs, mention your employment status, family obligations and intimate relationships, too, says Dr. Wetmore.

5. Be a better googler

Doctors know you do it (hello, late-night web searches), but they would prefer you to ask about good sources of information, rather than going rogue online. They also want you to be honest about your fears if you’ve read something particularly upsetting. Physicians can’t address your concerns or point you in the right direction if they don’t know what your fingertips have been up to. “The thing we want our patients to do is ask us for the most reliable Canadian websites to go to as resources,” says Dr. Heather Waters, an assistant professor of family medicine at McMaster University in Hamilton.

6. Don’t think your symptoms are “no big deal”

If you’ve noticed you are having more headaches than usual or are sleeping more or are eating less, you might not think to tell your doctor—but you should. There’s no set of rules for determining which symptoms are worthy of investigation or discussion, says Dr. Wetmore, but make a note to mention anything that is new or has changed since your last appointment. “You should bring up things like sudden weight loss or fatigue that seems excessive,” he says. “It could be a sign of a larger problem, or the cause of a developing problem.” Evenif it doesn’t end up being serious, seeing your doctor will help ease any anxiety you might be feeling, and that’s worth the visit, too.

7. Talk about what you’re taking

Tell your physician about any herbal medications and alternative treatments you take, says Dr. Mel Borins, a University of Toronto associate professor and author of A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t, and Why. It’s important for patients to share what’s working for them and for doctors to be open-minded about therapies outside their own practice or traditions, he says. This is also a concern when it comes to conventional meds, especially if you’re pregnant; there are only 23 medications specifically approved for use during pregnancy— yes, out of every available drug—which can leave women feeling anxious about taking prescription or over-the-counter drugs when they’re expecting, says Dr. Robyn MacQuarrie, an obstetrician-gynecologist in Bridgewater, N.S. But don’t stop taking your meds as soon as your pregnancy test comes back positive. “It’s really important to talk to your doctor instead of stopping cold turkey,” says Dr. MacQuarrie. Physicians can help you determine the risks and benefits of using different drugs, and they can let you know when the effects of not taking a medication while pregnant may be worse than taking it— which is the case with some antidepressants.

8. Avoid diagnosing yourself

You know doctors don’t like it when you come in prepared with a diagnosis you’ve made thanks to the aforementioned Dr. Google. But do you know why? It’s not because they think you’re encroaching on their territory! Rather, they worry that a serious medical problem might get missed or you’ll cause yourself unnecessary anxiety over something not serious. That’s because not everyone has the most common symptoms of a particular condition. Plus, men, women and different ethnicities can have varying symptoms for the same problem. For instance, Dr. Reade’s community has a large proportion of people with diabetes, which can affect the warning signs of cardiac disease, a major killer in Canada. Instead of the usual pain or pressure on the left side of the chest or arm, men and women with diabetes may instead have spells of profuse sweating with weakness. And, of course, women who don’t have diabetes can have differing symptoms, too; sometimes, a heart attack can feel like acid reflux or come with sudden nausea, vomiting and lightheadedness. So always tell your physician if your symptoms are surprising or strange—like a headache that feels different than usual, for example. And if you’re worried about a specific diagnosis, be sure to bring that up, too.

THURSDAY, April 28, 2016 (HealthDay News) — Macho men are less likely than women to visit a doctor, and more likely to request male physicians when they do make an appointment, researchers say.

But these “tough guys” tend to downplay their symptoms in front of male doctors because of a perceived need to keep up a strong front when interacting with men, according to three recent studies.

The results can be dangerous.

“These studies highlight one theory about why masculinity is, generally, linked to poor health outcomes for men,” said Mary Himmelstein. She is co-author of three recent studies on gender and medicine and a doctoral candidate in the department of psychology at Rutgers University in Piscataway, N.J.

“Men who really buy into this cultural script that they need to be tough and brave — that if they don’t act in a certain way they could lose their masculinity (or) ‘man-card’ (or) status — are less likely to seek preventative care, and delay care in the face of illness and injury,” Himmelstein added.

According to the U.S. Centers for Disease Control and Prevention, men born in 2009 will live five years less than women born the same year, a spread not fully explained by physical differences, the researchers noted.

To see whether the male psyche drives some men to undermine their own health, Himmelstein and co-author Diana Sanchez asked roughly 250 men to complete an online survey on gender perceptions and doctor preferences. The answers revealed that those with more masculine leanings were more likely to choose a male doctor.

Another 250 men — all undergraduate students — participated in a staged medical exam conducted by male and female pre-med and nursing students. The upshot: The more macho the patients, the less honest they were with their male caregiver.

Those two trials were reported recently in the journal Preventive Medicine.

A prior study conducted by Himmelstein and Sanchez — published in the Journal of Health Psychology — involved gender-role interviews with nearly 500 males and females. It found that guys with traditional masculine ideals were less likely to seek health care, more likely to downplay symptoms, and had worse overall health compared with women and less masculine men.

The research team also found that women who viewed themselves as “brave” or “self-reliant” were also less likely to seek care or be honest about their health status with doctors than women who didn’t strongly embrace such characteristics.

But Himmelstein said she wouldn’t expect women to behave exactly the same as tough men across the board because “women don’t lose status or respect by displaying vulnerability or weakness.”

Timothy Smith, a professor of psychology at Brigham Young University in Provo, Utah, said these findings reflect long-standing social forces.

“Cultural beliefs, such as toughness, develop for a reason,” he said. “Decades ago, when our economy depended predominantly on manual labor, the ability to continue working despite (problematic) physical conditions benefited families dependent on that labor.”

Today, however, with effective health care much more accessible, equating toughness with denial of health conditions has dangerous consequences, he noted.

“The belief that disclosing physical illness indicates emotional weakness is absolutely false,” added Smith.
If you suspect a loved one or family member is avoiding medical treatment for fear of appearing weak, Smith suggested sharing these findings with him. “It is better to confront denial than delay treatment. When people fear to share their illness with a physician, they deny themselves and their family and friends the benefits of recovery,” Smith said.

Himmelstein added, “Just encouraging a tough guy to have a regular physical or see the doctor when sick would help.”
Also, she added, finding a doctor and an office setting in which patients feel at ease is “incredibly important.”

Do you have a therapist? What about a psychiatrist to prescribe medication? How do you feel about them? Mental health care has become a controversial field for many reasons but most clients and families are fearful of being mistreated, misdiagnosed, used, misunderstood, controlled, and mistreated. It is a sad reality that fearful and uncertain clients drop out of therapy completely. Others may self-medicate or speak to and learn from family and friends who can offer suggestions or “therapy” for free. In my sessions with clients, I often remind parents and families that they have, what we can conceptualize as, 50% control over their treatment. For example, clients can decide who to see for therapy or medication management, refuse to pay for services that they are not satisfied by, file a grievance if they are not satisfied with their service, among many other things. This article will review and discuss some of the things that you should keep in mind while seeking mental health care for yourself or someone you love.

It is important that we all research what we are being told by a healthcare professional and research the type of medication being prescribed, the diagnosis, and other important factors involved in healthcare. I often provide http://www.drugs.com to my client’s and their families to research medications prescribed. But there are many other sites that can offer education and insight into mental health challenges.There are also thousands of websites, apps, and articles on everything from depression, anxiety, and suicidal thoughts to sleep disorders, personality disorders, and impulse control disorders. Social media provides multiple avenues to research and confirm a diagnosis. Unfortunately, there are some clients who simply rely on the knowledge and experience of the therapist or mental health professional treating them. This is not the route to take as independence and self-knowledge will be the most important tool when pursuing mental health services. Independence begins when you take control of your treatment. Some things to remember to kick-start the process include:

You (or those close to you) truly do know you better: It is often very disappointing to hear my client’s discuss how overly confident, arrogant, and self-assured their previous therapist or psychiatrist was while treating them. It is even more disappointing to find out that every decision that has been made in the life of a client was influenced by the healthcare professional and not the individual client or those close to the client. Many of my teen clients seek outpatient care hoping that they will once again regain their level of independence in making decisions on the type of medications they would like to try and the type of providers they hope to see. Unfortunately, there are some providers who will take the reigns and do whatever they see fit for a client without truly listening to the needs of the client and family. Don’t forget that you (and those you designate) should be making the ultimate decisions on your healthcare. Recommendations or suggestions by healthcare professionals are just that, recommendations or suggestions but they should never take your freedom to make the final decision.

Professionals don’t always know how to correctly conceptualize your illness: It is a known fact that the field of psychology is not an exact science. We have come a very long way in studying, diagnosing, and treating certain mental illnesses. We have also come a long way in identifying illness. But this does not mean that we always know what something is, we always know how to treat something, or we always know how to make sense out of symptoms. If you haven’t noticed already, the DSM (and its many revisions) is simply a guide to mental health professionals and an organized way to communicate with other professionals and patients/clients who are seeking care. The best way to conceptualize the DSM is to see it as a manual that guides mental health professionals in making sense out of symptoms but does not, in any way, always accurately describe an illness. This is why so many people are misdiagnosed, misunderstood, and are unable to obtain necessary services to treat symptoms. For example, depression symptoms (low level of motivation, anhedonia, depressed or sad mood, delusional thinking or other psychotic features, confusion, appetite difficulties, sleep difficulties, and suicidal thoughts) can be very similar to the negative features of schizophrenia or a personality disorder such as borderline personality disorder. It is likely that a mental health professional (or even professionals) can misdiagnose you or someone you love. This is not unheard of. Motivation to learn about, research, confirm, and even questions symptoms/diagnosis will help you or a loved one avoid confusion and obtain the services that can be helpful in recovery.

Some healthcare professionals are motivated by selfish gain: It is also a known fact that some mental health professionals are in the field for personal reasons. Those personal reasons can include but are not limited to: attention, a certain level of power (through authority as someone who can make decisions on someone’s life, supervising, or making organizational changes within an agency), personal challenges with mental health (one’s own illness, a friend, or family), financial freedom (primarily for those individuals who obtain a doctorate in psychology and can teach at Colleges, write prestigious books, etc.), independence (by having one’s own business or practice) among many other reasons. It is important to add that many mental health professionals are not in the field for financial gain or any other reason than to help and make necessary changes in the field. But it is also reality that some seek internal gratification by becoming a part of the field. That being said, you should question the motivation of a mental health professional and seek someone who truly wants to help.

Everyone with a shingle/degree/certification is not always informed or helpful: It is important to research your healthcare professional before you meet with them. There are all kinds of rating sites that help you determine if you should meet with or continue to do business with a mental health professional. Some ratings can be biased, while others are very helpful. Choose your information wisely and ask around your local area. Word of mouth is sometimes useful in helping you make decisions. It is also important to keep in mind that not every professional with a certification or degree can understand your needs. Finding a competent mental health professional can take time so do your best to research, evaluate, and determine what you need.

Most people know themselves best: Believe it or not, many of us can be our own mental health therapist by engaging in introspection (looking within). This, of course, is not always possible due to the fact that some illnesses are very severe and require professional attention. It is important to avoid self-diagnosis because sometimes it can cause more problems than you think. However, we often know ourselves well and can typically make decisions for ourselves. That being said, it is okay to be the judge of what you need sometimes. A mental health professional will assist you (when appropriate), support you, and offer treatment but they should not make decisions for you, tell you how to think or feel, or control your life.

Arrogance, complacency, popularity, favoritism does not = professionalism: It is sad but a lot of people believe that if someone is overly confident, complacent or comfortable in the work they do (i.e.,their profession), popular, and appears to be favored by reputable people that the person must be competent, friendly, and caring. Think again. We should all aim to avoid judging people based on their status alone. My experience over the past 6-7 years has been that each therapist has a different clinical style, life goals, perspectives on life, trainings, different values and morals, etc. that influences not only their personal life but their job. If you sense the slightest amount of arrogance or notice any negative traits, move on and start researching. You deserve more than that.

Scientific studies confirm that a placebo (a dummy medication or procedure) can genuinely benefit a person’s health. But its sinister cousin, the “nocebo effect,” creates expectations of harm, which can lead to seriously negative health consequences.

A patient’s expectations of a treatment clearly influence the way it works. The authors of a 2012 German study note that vulnerable, ill, or injured patients are highly receptive to negative suggestion. A participant in one drug trial developed dangerously low blood pressure by “overdosing” on what he thought was an antidepressant—only when he learned that it was an inert substance did his blood pressure return to normal. (Conversely, the power of positive suggestion may explain some of the success of complementary therapies—from herbal remedies to homeopathy). The more strongly a patient believes in the treatment, the more likely it is to be effective. Here are some ways you can put this knowledge to practice:

1. Get authoritative information Before having treatment or taking medication, get advice from a reputable source. The Internet is a vast repository of information but obviously not all of it is reliable. If you have a tendency toward hypochondria, it can be more harmful than helpful, as the nocebo effect is known to influence those who have a pessimistic outlook more powerfully than those with a more balanced attitude.

2. Control your response to health experts who are treating you. Focus on encouraging phrases, such as “most people tolerate this well” or “this shouldn’t hurt.” Try to tune out the negative comments, such as “this may be painful,” “expect a long recovery time” or “you may find that this treatment makes you feel sick.”

3. Engage your mind Use creative imagery to stay positive while you recover from illness. If you are in pain, for example, it may help to imagine tight muscles being massaged, visualize the muscle fibers separating and relaxing, and to concentrate on feelings of warmth. As you visualize, try to focus on your breathing and imagine that you are relaxing in the sunshine or floating in a pool.

4. Use the power of touch Studies have shown that the touch of a partner, friend, or health practitioner can benefit conditions as diverse as asthma, arthritis, hypertension, and migraine. Touch therapy has also been proven to reduce pain and accelerate wound healing. Even if, as some maintain, this is a placebo effect, it is the end result that is significant.

5. Keep positive There is overwhelming evidence that those who heal fastest maintain a positive attitude, take responsibility for their own health, and focus on getting well. Self-awareness also helps, especially of attitudes that may hamper your health.

Like this:

People with multiple chronic illnesses often must take charge of managing their own care

By SUMATHI REDDY Aug. 10, 2015

One in four Americans lives with more than one chronic illness; three out of four among those 65 and older.

Managing those people’s health care is often difficult. Integrated health systems, such as Kaiser Permanente and Mayo Clinic, aim to ensure that treatment for one condition doesn’t interfere with care the patient is receiving for other diseases. Often, however, the responsibility of coordinating treatments falls on the patients themselves.

“Conflicts between medications, and doctors that don’t talk to one another, is a big and common problem,” said John Piette, director of the Center for Managing Chronic Disease at the University of Michigan School of Public Health. “People have difficulty managing both symptoms and side effects of multiple medications,” he added.

The Department of Health and Human Services (HHS) in July issued a free curriculum for training health-care professionals and others in how to care for patients with multiple chronic conditions. The curriculum includes strategies to help patients keep track of their own care by involving caregivers, for example. For patients who have a hard time taking numerous daily medications, doctors should tell them which drugs are most important, the curriculum recommends.

HHS has taken other steps to address the needs of patients with multiple chronic conditions since launching an initiative in 2010 to study the issue. The Centers for Medicare and Medicaid Services, an agency within HHS, began this year reimbursing health-care providers for time spent coordinating the care of those patients outside of regular office visits.

The department also seeks to ensure that people with multiple chronic conditions are included in clinical trials. “That’s important because we want to make sure that when drugs come on to the market that they are truly safe and effective for patients with multiple chronic conditions,” said Dr. Anand Parekh, HHS deputy assistant secretary for health.

For many patients, multiple chronic conditions, such as obesity and diabetes, are related, or what is called concordant. Other patients have completely separate conditions, such as epilepsy and cardiovascular disease, which are known as discordant.

‘Conflicts between medications, and doctors
that don’t talk to one another, is a big and common problem,’
says John Piette, director of the Center for Managing Chronic Disease
at the University of Michigan School of Public Health.

Electronic health records can help doctors keep track of the varied care patients might be receiving, especially when they see multiple specialists at the same hospital or medical center. Patients shouldn’t necessarily rely on this, however, said Dr. Piette, who is also a senior scientist in the Veterans Health Administration. Ultimately, it is the patient who has to be “a proactive consumer of health care and in charge of managing their multiple conditions,” he said.

Sometimes different specialists give a patient conflicting advice. In this case, patients should write down as much information as possible when talking to each doctor and let them know about the apparent conflict, Dr. Piette said. Patients could also encourage the doctors to talk to each other if needed, he said.

Victor Montori, professor of medicine at the Mayo Clinic in Rochester, Minn., talks about the “work of being a patient,” which involves more than keeping up with one’s medications. Patients must also educate themselves about the health care they need, said Dr. Montori, who is also lead investigator of the clinic’s Knowledge and Evaluation Research Unit, which seeks ways to adapt care for individual patient’s needs.

Doctors who prescribe medications should be responsible for taking into account the patient’s various illnesses, Dr. Montori said. If clinicians don’t have the expertise to understand potential drug interactions, they should seek advice from a pharmacist, who is trained to deal with problems that arise when patients take many drugs, he said.

Dr. Michael Munger, a family physician in Overland Park, Kan., says he sees himself as a quarterback, coordinating care for his patients with multiple chronic conditions. That means ‘getting the patient to the right care at the right time and making sure the information – past medicines, medical history – is available,’ he says.

Dr. Montori recommends patients build their own version of a medical record by keeping a complete and updated list of medicines handy and bringing it to all doctors’ visits. And if the demands of being a patient become overwhelming, talk to the doctor, he said. For example, as a diabetes doctor, Dr. Montori might ask patients to check their blood sugar several times a day. When this is difficult for a patient to do, some checks can be eliminated in cases when they are less critical, he said.

He also recommends that patients who aren’t in an integrated health system seek out a “quarterback” to keep an eye on the big picture and help coordinate their care. Usually this is a primary care doctor or an internist, or in some cases the specialist who the patient sees the most. For a cancer patient, for example, the oncologist will often take on that responsibility. Family members can also help by keeping track of treatments for multiple illnesses.

Michael Munger, a family physician in Overland Park, Kan., said he regularly coordinates care for his patients, most of whom have multiple chronic conditions.

That part of the job, he said, means “getting the patient to the right care at the right time and making sure the information—past medicines, medical history—is available.”

Dr. Munger says he always starts visits by going over a patient’s medication list. “Most of my patients have it tucked in their purse or their wallet,” he said. “I have them pull that out so we can review it and make sure it’s current.”